Impregnation device for locating the site of internal bleeding



Jan. 14, 1969 j R. s. BRAY ETAL 2 9 IMPREGNATION DEVICE FOR LOCATING THESITE OF INTERNAL BLEEDING Filed Dec. 20, 1965 Inventors.- fiws'soll *5.Bray, Frederick Z.Ha user,

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United States Patent 3,421,499 IMPREGNATION DEVICE FOR LOCATENG THE SITEOF INTERNAL BLEEDING Russell S. Bray, 237 Wayland Ave, Providence, RI.

02906, and Frederick L. Hauser, 235 Don Ave., Rumford, R1. 02916 FiledDec. 20, 1965, Ser. No. 514,832

U.S. Cl. 128--2 Int. Cl. Afilb 6/00 1 Claim ABSTRACT OF THE DISCLOSUREThe present invention relates generally to the surgical arts, and ismore particularly concerned with the provision of a novel and improvedimpregnation device for locating the site of internal bleeding, andparticularly gastrointestinal bleeding.

It has heretofore been conventional to locate the site ofgastro-intestinal bleeding by utilizing an impregnation string that isswallowed by the patient. More specifically, impregnation strings ofthis general type traditionally comprise some sort of a radiopaque corehaving longitudinally spaced radiopaque marking members attachedthereto. The core and marking members are covered by an absorbentsheath, preferably of soft woven or knitted fabric or braided tubing,and the distal end of the string is provided with some sort of asuitable weight. The string is then swallowed by the patient, it beingunderstood that the distal weight will facilitate travel of the stringthrough the patients esophagus, stomach and duodenum, it being furtherunderstood that the proximal end of the string is always maintainedoutside of the patients mouth. Once the string has settled in thepatients stomach and duodenum, an X-ray is taken, whereupon theradiopaque portions of the string enable the diagnostician to know justhow the string is positioned within the patient. The string then remainsin the patient for a sufiicient period of time, which in many cases maybe many hours. The string is then withdrawn from the patient, and theabsorbent sheath is inspected for evidence of blood. Once blood has beenlocated on the absorbent sheath, it is an easy matter to correlate theposition of the blood on the sheath with a specific site in the patientsgastro-intestinal tract, this being done by referring to the X-ray andthen establishing in the X-ray the precise positions where blood appearson the string, this being facilitated by the spaced radiopaque markingswhich show up in the X-ray.

Certain disadvantages have been found to exist in the prior artimpregnation strings used for carrying out the above-describedprocedure. First of all, when the patient is X-rayed, it is frequentlyvery difiicult to detect the radiopaque core in the X-ray, even thoughthe spaced radiopaque markings are usually clearly visible. The problemhere is that where the core itself is not clearly visible in the X-raythroughout its entire length, it is frequently very difficult toproperly correlate the spaced radiopaque markers, particularly since itoften happens that the string is looped and intertwined Within thepatients stomach, thus raising the possibility that one marker may bepositioned substantially behind another marker so as to be obscuredthereby when the X-ray is taken. If, on the other "ice hand, theradiopaque core itself were clearly visible in the X-ray, then it wouldbe possible to readily ascertain when one marker is being obscured byanother.

Another disadvantage that has existed heretofore in impregnation devicesof the type above described is the fact that, although highly flexible,the device has sufiicient body so that when in a patient for extendedperiods of time, irritation and discomfort to the patients esophagus,throat and mouth frequently result.

A further disadvantage in prior art devices of the instant type residesin the fact that the distal weight is frequently not as effective as isdesired, and is often sornewhat difficult to assemble to the string.

It is therefore a primary object of our invention to provide animpregnation device of the character described wherein the core of thedevice is so constructed as to be radiopaque throughout its length insuch a way that the entire length of the core will show clearly in anX-ray.

Another object of our invention is the provision of an impregnationdevice of the character described that is so constructed as to greatlyminimize any irritation or discomfort to the esophagus, throat and mouthof the patient.

A further object is the provision of an impregnation device of thecharacter described having a novel and improved distal weight, which isnot only highly effective in use, but which also is relatively easy toassemble to the device.

Another object is the provision of an impregnation device of thecharacter described having novel and improved radiopaque meanslongitudinally spaced on the core of the device.

Still another object is the provision of a novel and improvedimpregnation device of the character described that is not only highlyeffective in use, but which is also relatively simple and economicallyfeasible to manufacture.

Other objects, features and advantages of the invention will becomeapparent as the description thereof proceeds when considered inconnection with the accompanying illustrative drawings.

In the drawings which illustrate the best mode presently contemplatedfor carrying out the instant invention:

FIG. 1 is an elevational view, partly in section, of an impregnationdevice constructed in accordance with the instant invention; and

FIG. 2 is a diagrammatic view showing the instant device operativelypositioned in the gastro-intestinal tract of a patient.

Referring now to the drawings, and more particularly to FIG. 1 thereof,there is shown generally at 10 an impregnation device constructed inaccordance with the instant invention. More specifically, theimpregnation device 10 comprises an inner core 12 of any suitable highlyflexible material, although we have found that it is preferable to use asolid extruded rubber core. It is conceivable, however, that the corecould be of other flexible materials, and also that the core could betubular rather than solid. Whether the core is solid or tubular, it willbe noted that its outer diameter is relatively substantial, and inpractice it has been found that a core having an outer diameter in theneighborhood of is actually quite feasible. The core 12 is maderadiopaque, preferably by barium impregnation of the core. Suitabletechniques exist for barium impregnating a solid extruded rubber core,and this is one of the reasons why a solid extruded rubber core ispreferred. In any event, it is important that the core 12 be radiopaquethroughout its length, and it has been found that this objective isnicely achieved by barium impregnation thereof.

At longitudinally spaced intervals along the length of the core 12 thereis provided a plurality of radiopaque markers 14. The markers 14 arepreferably of any suitable radiopaque metallic material and are in theform of circular collars which encircle and grip the core 12 at thedesired spaced intervals. As will be clearly seen in FIG. 1, the collars14 compress core 12 so that the outer diameter of the collars is onlyslightly greater than the diameter of core 12 in its relaxed state.

Surrounding the core 12 throughout its length is an absorbent sheath 16,preferably constructed of a braided woven or knitted soft fabric, suchas cotton. It will be noted that the sheath 16 snugly encompasses core12 and the spaced markers 14 located thereon throughout the length ofthe core 12. Adjacent the proximal end 18 of the core 12, the sheath 16is tightly secured thereto such as by tightly winding a suitable thread20 around the sheath to cause it to tightly grip the core. As will benoted, the sheath 20 extends proxirnally beyond the end 18 of the core12 and receives a string 22 which is knotted as at 24. The string 22 issecurely attached to the sheath 16 by tightly binding suitable threads26 around the sheath so as to cause the latter to tightly grip thestring 22, as will be obvious in FIG. 1. The knot 24. will, of course,prevent string 22 from being withdrawn from the proximal end of sheath16, thus securing the string 22 to the cored sheath so as to form anaxial extension of the latter, the purpose of which will hereinafter bedescribed. It will be understood that the string 22 can be constructedof any suitable material, and even rubber could be used, in which eventthe rubber core 12 could continue outwardly from the sheath to functionas the string.

At the distal end of the device 10 there is provided a weight showngenerally at 28. As will be noted, the weight 28 comprises a cylindricalmetallic housing 30 having a reduced aperture 32 at its proximal end andbeing open at its distal end as at 34. Adjacent its distal open end, thehousing 30 is internally threaded as at 36 so as to threadably receivethe threaded shank 38 of end cap 40. It will be seen that the aperture32 is of suflicient size to snugly receive therethrough the cored sheathwith the distal end of the latter being knotted as at 42 so as toprevent the cored sheath from being withdrawn through the aperture 32.

In assembling the cored sheath to the weight 28, it is simply necessaryto thread the former through aperture 32 sufiiciently so that it extendsthrough open end 34. The cored sheath is then knotted, after which thehousing 30 is slid downwardly along the cored sheath until the knot isengaged, as illustrated in FIG. 1. .The open end of the housing 30 isthen covered by threadably inserting the end cap 40. It will be seenthat the weight 28 is of of a smooth elliptical configuration and thatthe end cap comprises a smooth continuation of the contour of the weight28, so as to insure that there are no sharp corners or edges such asmight cause internal damage to the patient and so as to facilitateswallowing of the weight by the patient.

As illustrated in FIG. 2, the cored sheath 16 is of sufficient length soas to extend through the patients stomach 44 and duodenum 46 withoutextending appreciably into the patients esophagus 48. String 22 in turnis of sufiicient length to extend through the patients esophagus 48,throat 50 and out through the patients mouth 52.

For reasons hereinafter to be made apparent, the core 12 is preferablywhite.

In use, the patient swallows the weight 28, which, due to its smoothelongated configuration, is relatively easy to swallow. The weightpasses through the patients esophagus, stomach and duodenum until thesheathed core assumes the general position illustrated in FIG. 2. Itwill be noted that very little of the sheathed core is in the patientsesophagus, and it will be further noted that the string 22 extendsthrough the patients esophagus and throat, and the outer end of saidstring is at all times maintained outside of the patients mouth. Withthe device 10 in this position, an X-ray is taken of the patient; anddue to the fact that the core 12 is barium impregnated, and due furtherto the fact that it is of relatively substantial outer diameter, theentire length of the core will show clearly in the X-ray and will beeasily traceable thereon, no matter what convolutions or loops the coremay have assumed within the patients stomach. At the same time, thespaced radiopaque markers 14 are clearly visible in the X-ray, due firstof all to the fact that the markers 14 are somewhat larger in diameterthan the core 12, and also due to the fact that the metallicconstruction of the markers renders them radiopaque to a greater degreethan the barium impregnated rubber.

The device 10 is allowed to remain in the patient for a sufiicientlength of time, which in many cases involves several hours and sometimesthe better part of a day or more. After sufficient time has elapsed, thedevice 10 is removed by withdrawing it through the patients mouth; andthe absorbent sheath 16 is then inspected for blood stains. The factthat the rubber core 12 is preferably white enables the blood stains tobe more dramatically visible, particularly where the sheath 16 is ofsomewhat loose weave. Expressed differently, if the core 12 were of aconventional rubber red color, the red color might possibly show througha loosely woven sheath 16 and be mistaken for blood stains. In anyevent, once blood stains have been located on the sheath 16, it is asimple matter to correlate the location of the blood stain with theclosest markers and then go to the X-ray; and by detenmining thelocation of those same markers in the X-ray, it is then an easy matterto determine the actual situs of the internal bleeding in the patient.

The fact that when in use the portion of the device 10 that is in thepatients esophagus and throat is the relatively thin and soft string 22results in minimal irritation and discomfort to the patient. Expresseddifferently, it has been found that where an impregnation device is ofsubstantial body, as is the cored sheath portion of the instantinvention, for example, and where such a relatively substantial deviceextends through the patients esophagus and throat, in many cases extremeirritation and discomfort result. The instant invention has neatlyovercome this problem by providing the string 22 at the proximal end ofthe cored sheath, whereupon the relatively bulky cored sheath is neverin the patients esophagus and throat for any extended period of time. Atthe same time, the cored sheath is positioned in the areas whereinternal bleeding is likely to be located.

The weight 28, although of simple construction, has proven to be highlyefifective, both from the standpoint of being relatively easy to swallowand of performing its desired weight function, but also due to its easeof assembly to the cored sheath, as aforedescribed. Likewise, the bariumimpregnated rubber core 12 has been found in practice to represent adecided advance and improvement over prior art radiopaque cores due tothe fact that the instant core is so much more easily visible andtraceable in an X-ray picture than are the radiopaque cores of prior artdevices presently in use. 1

While there is shown and described herein certain specific structureembodying the invention, it will be manifest to those skilled in the artthat various modifications and rearrangements of the parts may be madewithout departing from the spirit and scope of the underlying inventionconcept and that the same is not limited to the particular forms hereinshown and described except insofar as indicated by the scope of theappended claim.

What is claimed is:

1. An impregnation device consisting of an elongated rubber coreimpregnated with a material making the core radiopaque throughout itslength, a plurality of longitudinally spaced metallic collarssurrounding said core in clamping relation thereto, said collarscompressing said core at the locations on the latter where said collarsare secured, said collars being of sufilciently thin metal stock so thatthe outer diameter of the collars, when attached to the core, is onlyslightly greater than the outer diameter of the relaxed core, a softabsorbent sheath snugly encircling said core and collar assembly, saidsheath being knotted just beyond the distal end of said core, a weightat the distal end of said core, said weight comprising a metallichousing having an aperture through which said sheathed core extends,said knot being located within said housing and preventing removal ofthe weight from the sheathed core, and a flexible mouthpiece portion oflesser diameter than said sheathed core extending axially from theproximal end of said sheathed core, said mouthpiece portion being of alength as to extend through the mouth and esophagus of a patient, andsaid sheathed core being of a length as to extend through the patientsstomach and duodenum.

References Cited UNITED STATES PATENTS Kiinsztler 128356 Billings 128--2Haynes et al. 1282 Nissenbaum et a1 1282 Mazellan 128--2 Pittman 128-2Mazellan 1282 RICHARD A. GAUDET, Primary Examiner.

K. L. HOWELL, Assistant Examiner.

US. Cl. X.R.

